Welcome to the April 2012 Carnival of Natural Parenting: Kids and Personal Care

This post was written for inclusion in the monthly Carnival of Natural Parenting hosted by Code Name: Mama and Hobo Mama. This month our participants have shared stories, tips, and struggles relating to their children’s personal care choices.

When Kieran was three years old, he had to be anesthetized for a dental procedure.1 The procedure was too extensive for Novocaine or Versed, and so we did a lot to prepare Kieran for what would happen at the dentist’s office. Today I’d like to share with you the basics of what happened during the procedure, along with some tips on how to prepare your child for anesthesia specific to dental work.

What Happened During the Dental Procedure

On the evening before Kieran’s appointment, we were to cut off food after dinner (his appointment was to start at 7:00a.m.). He could have clear liquids for another few hours after that, but basically he was not to have anything to eat or drink after he went to sleep. Your dentist will tell you exactly when to stop giving your child food or drink. For breastfeeding children, Kellymom advises that “the most current studies say that babies can safely nurse 3-4 hours prior to surgery.” Be sure to discuss breastfeeding protocol with your anesthesiologist, and do not be afraid to cite recent studies.

The procedure itself started with a quick medical history and vital signs check (blood pressure and heart rate) by the anesthesiologist’s assistant.2 Once they were ready to start, the anesthesiologist gave Kieran a quick shot in the bottom – this helped him get into a “twilight state” so that the anesthesiologist could start the IV. I had written down exactly what medications were used on Kieran, but that paper is long gone. I believe that the shot prior to the IV was something similar to Versed – it didn’t knock Kieran out all the way, but he was completely out of it and unresponsive after the medicine took effect.

Kieran was on my lap for the shot – I was holding him (with him facing me) in a tight hug so that he could not squirm off. In less than five minutes, the medicine had taken effect and I had to turn my baby over to the anesthesiologist to start the IV. We were not allowed to be in the room for the rest of the procedure. On a side note, I want to warn parents that the “twilight state” induced by the shot was probably the hardest part for me. It’s hard to see your baby unresponsive, glassy-eyed, and slack-jawed. As soon as I felt him go limp in my arms and I looked into his face, I lost the composure that I’d been fighting very hard to keep all morning.

An hour later, the anesthesiologist told me that Kieran was starting to rouse, but that they did not want us to go back to him until he’d really started to wake up. I was frustrated by this – I did not want Kieran to be at all awake or alert without me in the room. However, the anesthesiologist’s idea of awake and my idea of awake were worlds apart – once we were allowed back to his room, Kieran was in no way aware of our presence (or the lack thereof).

It took Kieran a good 15-20 minutes to be awake enough for us to get him ready to go home. He was still super groggy in the car, but he was awake enough to make comments liked “What happened to my cavities?,” “I’m wobbly,” and “Usually when I go to the dentist they give me ice cream!” Heh.

Overall, the procedure was much more anxiety-producing than it was actually painful. Kieran did cry and express how scared he was when we were getting ready to leave for the dentist, but he was better once we were in the car. After he woke up, he enjoyed getting to drink a Sonic slush, and he thought it was pretty cool that we stayed in bed together the rest of the day eating soft, fun foods.

So how did we prepare him for anesthesia at the dentist? Keep reading!

Preparing Your Child for Anesthesia During a Dental Procedure

If your little one needs to have dental work with anesthesia, you may be wondering how to help him prepare for it. Here are some ideas on how you can help prepare your child for the experience of anesthesia and dental work.3

Play Dentist

In one of the appointments before the big procedure, ask your dentist to give you some masks and gloves. Play dentist and let your child be in control. Act out the uncomfortable parts, with you being the uncomfortable child. Kieran loved to see me act scared and cry when he came at me with gloves. If your child is into doll play, use dolls to act out the appointment.

Decide What Your Child Needs to Know

Each parent will know the information they want to share and that their child can handle. For us, it is important that we share truthful information with Kieran, and he feels better when he knows exactly what is going to happen, so we chose to walk through everything with him in advance. Other parents may feel that sharing too much information may raise their child’s stress level more than is necessary.

The hardest part for us to deal with was explaining the shot. Some parents deal with this by describing it as a poke or pinch. We did tell him that there would be a shot, and we described the feeling as a pinch. We dealt with Kieran’s anxiety about the shot by acting it out.

Read Books

There aren’t specific books that I can find on this subject, but here are a few that might help prepare your child:

Tell Social Stories

Social stories were developed for children with autism spectrum disorders. Social stories “describe[] a situation, skill, or concept in terms of relevant social cues, perspectives, and common responses . . . .” They are intended to share information in a “patient and reassuring manner that is easily understood by its audience.”4

I’ve found several social stories about dentists and surgery online, you can use them to come up with your own. (For what it’s worth, some of the language in these stories makes me uncomfortable. For example, “The doctor might want to touch me. That is ok.” That phrasing does not sit well with me, because allowing any adult carte blanche permission to touch my child is never ok with me. I would change some of this phrasing. You might also be uncomfortable because at least one site says that a goal of social stories is to “gain compliance.” As always, use your judgment with these resources.)

Going Places (has several links for stories that include going to the doctor and going to the dentist)

Rehearse It

Some children might feel reassured by rehearsing the steps of the procedure. It may even help to incorporate some of these steps into a practice visit to the dentist. Rehearsing can help make the procedure seem more normal for some children.

Take It Step by Step

Your little one may feel overwhelmed by hearing about the whole procedure at once. You might try discussing it step by step, pausing to let her get comfortable with each part in turn. On the day of the event, concentrate on only one step at a time. When Kieran woke up for his appointment, we could not get him to budge from the bed when he was thinking about “going to the dentist.” But he became willing to move out the door when we talked about simply getting into the car and seeing how we felt from there.

Focus on the Good Parts (Including Anything Fun You’ll Do Afterward)

If your little one is food-oriented, you can talk up and plan out all of the fun soft foods he can eat after his dental work is done. Kieran helped me choose what he would eat for the 24 hours after the procedure, including – of course – ice cream.

Some dentist’s offices are really fun – your little one might leave with prizes, a balloon, etc. Our office has two beautiful aquariums that kids like to look at, but the bigger draw is the big TV (showing kids’ movies all day long) and video games kids can play while waiting.

If your little one is having any pain, be sure to talk about the fact that her mouth will feel so much better once the problem is fixed.

Reassure Him You’ll Be There

Kieran’s biggest fear (besides the fear of the unknown, I suppose) was being away from us. We reassured him that we would be with him up until the very point when he went to sleep. We also told him that we would be in the room when he woke up. He never asked about what would happen when he went to sleep, and I never felt it was necessary to volunteer that information. Additionally, we made it clear that we trusted the dentist to take good care of his mouth.

Bring a Comfort Object

Whether it is a blanket, a shirt that smells like mama, a doll, or a superhero costume, encourage your child to bring something that will make her think of home and of safety.

Give Your Child Some Control

It must be terrifying to be a child who feels compelled to submit to dental or medical work. As much as we talk it out and explain how necessary it might be, children are still apt to feel out of control. Give your child back some of that control in any way you can. For example, Kieran asked to wear his Batman costume (aka pajamas plus a mask and cape) to the dentist. Why not?! If he’d asked to go in his underwear I would have said yes (and then I would have slipped pajama pants on him when the medicine took effect).

Kieran also asked to play Angry Birds on a cell phone while we drove and waited. I would typically discourage video games for that length of time, but it did not matter in the least to me on that day.

He got to choose what he would eat on the day of his procedure. And when he decided after a bite that he did not like what he’d chosen, I just got him something else. It was the little things like that that made him feel a little bit more powerful.

Schedule Your Appointment Early

If your appointment is not an emergency, make every effort to schedule it as early in the morning as possible. This not only helps you avoid food struggles and hunger meltdowns, but it also gives your child less time to worry on the day of the procedure.

Dress Her Comfortably

Again, anything to make your child feel more safe and comfortable will make the visit go smoother. Let her pick out her outfit. By the way, I have heard that some anesthesiologists are able to administer the shot in the bottom through thin pajama pants. I’m pretty sure this is what happened with Kieran.

For little ones who are out of diapers, be aware that some people (grown-ups included!) will lose control of their bladder while under anesthesia. You may want to put your little one in a pull-up. We considered putting Kieran in a pull-up, but he got so anxious at the suggestion that I simply brought along an extra set of clothes in case he wet.

Stay Calm Yourself

Your child will take cues from you, so try to find a way to release your anxiety before the appointment and away from your little one. You might find that simple meditation will be helpful; Presence Parenting offers meditation practice helps that are wonderful.

Visualize

Visualization could be calming and useful for both you and your child. Think of this as sort of a social story in your imagination (and if you are using this for your child, try to give her some visuals to work with first – the trip to the dentist’s office, etc.). When you visualize the day of the procedure, go through each step out loud, calmly. Envision not only what will happen, but the calm, positive feelings you will be focusing on when you live through that step. (If you ever practiced visualization as a technique to help you with childbirth, that is what I’m thinking of here.)

Employ Distractions

Once you have done your best to explain the procedure, work through your child’s anxiety, make sure he is comfortable, and calm yourself down, you may find that some fun distractions are effective on the actual day of the procedure – especially if your child has to wait several hours without eating. Take her to a fun location (keep in mind that you a location one that does not have a lot of food vendors and will not deplete all of her energy, making her that much more hungry). For Kieran, it was video games. For your child, perhaps a book-on-CD marathon, a movie, a trip to a museum, etc.

How did you prepare your little one for a medical or dental visit that included anesthesia?

How to Gently Trim Your Toddler’s Nails — Shannon at The Artful Mama discusses some of the gentle suggestions she has received to help Little Man overcome his anxiety of having his nails trimmed, as well as how she copes with her need for his nails to be trimmed.

Confused About Chemicals? — Jaye Anne at Wide Awake, Half Asleep describes how to find out where the toxic chemicals are in your house and tips on alternatives.

Clipping Those Talons — ANonyMous at Radical Ramblings describes the ways her daughter’s tolerance for personal care has changed over time, especially when it comes to nail clipping.

Sit Back, Relax and Unschool Hygiene — Instead of focusing on tactics of how to ‘get’ your child to focus on hygiene, Authentic Parenting explains how to help your child internalize hygienic standards.

EC: All or Nothing? — Elimination Communication. Even the title sounds complicated and time consuming. It doesn’t have to, if you adapt it to meet your family’s needs, says Jennifer at True Confessions of a Real Mommy.

Routine Battles — In a guest post at Anktangle, Jorje of Momma Jorje outlines a simple incentive to help inspire your little one to follow a routine.

Redefining Beauty For My Daughter — Justine at The Lone Home Ranger relays her struggle to define her own femininity and how her preschooler unexpectedly taught her a lesson in true beauty.

Cleaniliness is next to… dirt — The lapse-prone eco-mom (Kenna at Million Tiny Things) sometimes forgets to bathe the kids. Except in the mud pit.

He got four caps on his four front teeth, with a root canal for each tooth. And yes, we have brushed and flossed the child religiously since he got teeth – he inherited my thin enamel. ↩

Of course we’d already given a full medical history weeks prior to the procedure, including getting what basically amounted to a well child visit. The check on the day of the procedure was to make sure nothing had changed in the past couple of weeks. ↩

Many thanks to the advice I received from friends (from Facebook and my local parenting group) when I was preparing Kieran for his own dental work. ↩

Thank you for all of this advice! We need to take Baby for his first dental checkup soon and I’m not looking forward to it. Luckily, our favorite playspace is hosting a free event next week which introduces the dentist and what happens there to toddlers and preschoolers. I’m hoping that will make me feel more prepared too.

Thank you so much! Two of my kidlets have had a lot of dental work, and I love the tips you included! I especially want to thank you for pointing out that it is not good to teach our children that *any* adult has the right to touch them. My cousin was molested by a dentist, and I was by a doctor. So often children are told that it is OK if it is a medical professional. :(

Very detailed and informative post. Our experience with our oldest was very similar. She didn’t have a shot, but instead drank some “happy juice” to get her relaxed before going back for her anesthesia. I think in our situation the Children’s Hospital made a huge difference. Our daughter has very fond memories of going there, she was treated like royalty and that’s what she remembers.
We recently discovered some t-rex dentist cartoons on Youtube that my son enjoyed. Preparing children for their first trip to the dentist is essential for a good experience. What a fabulous list of resources you’ve shared.

Such great tips, I’m definitely bookmarking this, although I do hope I will never need it. I have a serious phobia when it comes to the dentist, and I need to work through that quick, because I would hate for Jesse to pick up on that. Nearly time for his first check-up so I need to start practising opening mouths wide with him :)

Ugh I’m dreading this happening-I also have a slight dentist phobia, which isn’t made any better by the knowledge that the dentist actually did screw up and slice the inside of my lower lip (not all the way through, so there is only a scar on the inside) when I was like 5. Oh and my mouth is small so everytime I go I end up bleeding on both sides of my mouth from them stretching it out so much. And that I react badly to laughing gas and panicked and tried to escape while the took out my wisdom teeth (they finished the tooth they were working on, but left one in because they were scared they’d injure me)
Anyway, that’s a long way of saying that the remaining calm myself category will be my biggest challenge for me if my son every needs a dental procedure!

Thank you so much for this topic! As you know, we are having our share of dental woes with weak baby teeth. Sigh. We haven’t had anesthesia for that (probably should have!), but I’m going to use a lot of your tips anyway. I really wish we’d known what to expect from the first extraction, but now that we do, I find it very helpful for both of us to talk talk talk over what happens (since he has another one coming up). I’d also like to try role playing, but we’ll see how it goes — he can be very literal-minded and doesn’t always believe me when I say I’m (pretending to be) a different person. :)

Our only experience with anesthesia was when Mikko was ~11 months and had a minor surgery. I think it was harder on us than on him (I mean, what do I know? but from appearances, at least). I totally agree that the worst moments were those moments after the sedation took effect (for us, it was a liquid sedative, dyed red, that got everywhere). He just got so out of it, and then they picked him up and carried him away. Oh! My little baby… Like I said, harder on us. ;)

These are great tips. We haven’t dealt with anesthesia yet, but my daughter recently had an injury at the park and had to take an ambulance to the hospital to have her fingernail reattached. It can be traumatic to have control taken away from you when it comes to care of your children. As for going to the dentist, my daughter has a Sesame Street “Look and Find” Elmo book with a dentist page, and she brought it with her to the dentist to match up the pictures in the book with what she saw. If your child likes to read, I definitely agree with books being a good way to introduce the subject. Thanks for this post!

When my daughter was two, she had three cavities on her front teeth. Our first dentist we visited said she needed to be put under or given another strong drug which i can’t remember the name of right now. neither of those options sounded good to me. we asked around and found a dentist recommended to us who only uses general anesthesia when it’s seriously needed. he actually ended up not even numbing the area since those shots can be painful, and he was careful to work around and not disturb the nerve. with some prayers, my daughter did amazingly well. for normal checkups, this video helped us http://www.atriptothedentist.com/about.html (we get it from the library). i’m not saying that anesthesia shouldn’t be used, but i didn’t like that i felt like the dentist was taking the easy (and expensive) way out without considering the options.

I read the recent article in the New York Times about toddlers being given anesthesia for dental work and how this is a growing trend. I wonder how long this has been accepted dental practice? Was this happening when we were kids? All I remember is laughing gas for getting cavities filled!

Your story is very thoughtful and informative and will be a great resource for other parents dealing with this challenge.

Kerry-I think they are discovering that people like me who have bad reactions to laughing gas aren’t as rare as they thought, and that has been much of the impetus for the change to more general anesthesia…they don’t want to take the time to figure out who will and won’t respond well to laughing gas (and it can be dangerous when someone starts panicking and thrashing part of the way through a delicate procedure). I could be wrong, but that is what I’ve heard

That must have been such a difficult experience for you, but your suggestions are absolutely wonderful, Dionna! I was lucky that my kids only had to have cleanings at the dentist. My son was afraid of going to the doctor when he was a young toddler, though. For him, just reading books about going to the doctor made all the difference. :)

Such an informative list – thank you so much for sharing! I will be using some of these just to prepare for a dentist check up as it will be our little ones first. I am so hoping for a clean bill of health! If not, I’ll be back here for more of the tips.

I sure hope my little one adopts her father’s strong teeth instead of mine. Thanks so much for giving such indepth advice about dental visits and reducing anxiety of the occation for parents and little ones. This is definitely something I will keep in mind :)